A 78 y/o cattleman referred for treatment of refractory depression by his primary care provider reports continued thoughts of failure, lack of purpose in
... [Show More] life, lack of interest in ranching, fishing, hunting, or family since losing his driver's license due to DUI six months ago. Which of the following areas is an assessment priority?
A. Prior and current medications, dose, clinical response, side effects
B. Extent of alcohol use and motivation to reduce to safe levels
C. Thoughts of self-harm, plan, intent, access
D. Sleep patterns (early-middle-late awakening), sleep hygiene
C. Thoughts of self-harm, plan, intent, access
A 32 y/o Caucasian Catholic female patient presents for her therapy session. She is upset because she and her husband have been in an argument over finances. She does not work and stays at home to take care of the children. She reports feeling sad and has had thoughts of hurting herself. She has a past history of overdosing with Tylenol several years ago. Which of the following places her at high-risk for suicide?
A. age
B. gender
C. previous suicide attempt
D. marital status
C. previous suicide attempt
During a follow-up medication visit with a 13 y/o male, his mother stayed longer to ask the psychiatric mental health nurse practitioner (PMHNP) a question. Specifically, his mother states, "the school sent home information about the human papillomavirus and suggested my son see his primary care provider to get an immunization. Why did I get this information for my son? Furthermore, he is not sexually active." Which of the following would be the PMHNP's best response?
A. As your son's PMHNP, I cannot provide you with information about immunizations
B. I understand your concern with talking to your son about becoming sexually active. Let's address how to start the conversation.
C. Decisions about immunizations can be difficult. The Centers for Disease Control and Prevention recommend that all males between the ages of 11-12, or as early as 9 years of age, receive this vaccination. What concerns do you have?
D. You are correct, only females need to receive the human papillomavirus vaccination. The letter must have been sent to you by mistake.
C. Decisions about immunizations can be difficult. The Centers for Disease Control and Prevention recommend that all males between the ages of 11-12, or as early as 9 years of age, receive this vaccination. What concerns do you have?
What opening question or statement by a Psychiatric-Mental Health Nurse Practitioner facilitates communication at an initial visit?
A. Tell me your concerns and how I may be of help.
B. Tell me what you think the problem is.
C. What seems to be the problem today?
D. What problem does your primary care physician want us to evaluate?
A. Tell me your concerns and how I may be of help.
In evaluating the functional status of a 68 y/o woman who has depression, the Instrumental Activities of Daily Living Scale includes which of the following activities?
A. Using telephone
B. Filing taxes
C. Bathing
D. Toileting
A. Using telephone
An adult female patient has been prescribed an SSRI for an initial episode of major depression. She is fearful of side effects and of becoming suicidal. Which of the following initial responses is most appropriate?
A. SSRI's are the safest antidepressant medications and rarely cause suicidal thoughts. Try the medication and we can watch closely for any side effects.
B. SSRI's are generally quite safe and rarely cause suicidal thoughts. I could call you every few days to see if you are having any of these thoughts.
C. Have you ever had feelings of hurting yourself? If you took the medication and had thoughts like that, what would you do?
D. Have you ever had feelings of hurting yourself? If you took the medication and had thoughts like that, would you be willing to call the crisis hotline?
C. Have you ever had feelings of hurting yourself? If you took the medication and had thoughts like that, what would you do?
A psychiatric mental health nurse practitioner (PMHNP) is working in an integrated care clinic and his family nurse practitioner colleague asks for a consult. The family nurse practitioner asks the PMHNP what antidepressant to start for a patient who has a score of 15 on the patient health questionnaire 9 (PHQ9). What is the appropriate response?
A. A score of 15 on the patient health questionnaire indicates moderate depression, so the patient should be started on a selective serotonin norepinephrine reuptake inhibitor.
B. A score of 15 on the patient health questionnaire 9 indicates possible moderate depression, but a follow-up interview is required to assess for depression. I can see this patient today and further assess for depression and the appropriate treatment
C. A score of 15 on the patient health questionnaire 9 indicates severe depression, so you should start a selective serotonin reuptake inhibitor and an atypical antipsychotic.
D. A score of 15 on the patient health questionnaire 9 indicates moderate depression, so you can refer the patient to therapy and start an antidepressant
B. A score of 15 on the patient health questionnaire 9 indicates possible moderate depression, but a follow-up interview is required to assess for depression. I can see this patient today and further assess for depression and the appropriate treatment
An example of a screening tool that measures severity and tracks change in specific symptoms is
A. The mini-mental state examination (MMSE)
B. The behavior and Symptom Identification Scale (BASIS)
C. The Short Form 36 (SF-36)
D. The CAGE
A. The mini-mental state examination (MMSE)
A ten y/o child lost her father to an unexpected heart attack. Normally confident, sociable and an excellent student, her teachers and mother report that she has withdrawn, become disinterested in schoolmates and schoolwork, and easily becomes tearful if anyone mentions her father. What non-pharmacologic intervention would be most helpful at this time to facilitate her grieving and loss?
A. Play therapy
B. Individual therapy
C. Psychoeducation group
D. Bibliotherapy
C. Psychoeducation group
Which of the following risk factors is not amenable to lifestyle changes in reducing lifetime risk of depressive disorders?
A. Work-related stress
B. Stressful family life
C. Alcohol use
D. Personality
D. Personality
The Five A's for Health Behavior Change include the following:
A. Assess, Advise, Act, Access, Assist
B. Assess, Appraise, Advise, Act, Assist
C. Assess, Advise, Agree, Assist, Arrange
D. Assess, Appraise, Agree, Access, Arrange
C. Assess, Advise, Agree, Assist, Arrange
A psychiatric mental health nurse practitioner realizes she is frustrated and easily angered with one of her patients for no apparent reason. When discussing the situation with a colleague, she states the patient reminds her of her abusive stepfather. Which of the following best describes the nurse practitioner's reaction?
A. Countertransference
B. Displacement
C. Transference
D. Projection
A. Countertransference
Dementia screening for the general population is not recommended for the following reason:
A. The service has unknown balance of benefit and harm; current treatments have limited effectiveness in modifying instrumental activities of daily living
B. The service benefits few people; target condition has high prevalence in the chosen population
C. The service causes net harm in the target population; time involved in screening detracts from higher priority preventive health measures in general population
D. The service is unfocused for target condition: sensitivity and specificity of dementia screening measures do not currently warrant widespread use
A. The service has unknown balance of benefit and harm; current treatments have limited effectiveness in modifying instrumental activities of daily living
The World health Organization has predicted that depression will be the number one world health problem in the 21st century. Lifetime prevalence for major depressive episode is 12% (with a 5-17% range). Which of the following individuals has the greatest risk factors for major depressive disorder (MDD)?
A. 16 y/o, high school male, honors student, who runs cross-country track
B. 43 y/o, divorced woman, schoolteacher, raising three children
C. 58 y/o, married male, computer analyst, whose work requires frequent travel
D. 28 y/o, single woman, working toward partner in a large law firm
B. 43 y/o, divorced woman, schoolteacher, raising three children
A patient who works the night shift presents for a follow-up appointment to see the psychiatric mental health nurse practitioner (PMHNP) and states, "I can't sleep when I get home from work". Upon assessment, the PMHNP learns the patient recently started an exercise regimen and is now exercising after work. Which response about sleep hygiene should the PMHNP provide to the patient?
A. Exercise does not promote or help deepen your sleep, so you should consider making changes in your daily routine
B. Exercising is a good way to help you get sleep, so keep up your schedule and your body will adjust to your new routine.
C. Regular exercise helps with sleep, so continue to exercise, and when you get home, watch television to help promote sleep
D. Regular exercise can help promote sleep but should not be performed too close to your bedtime or it can interfere with sleep; try exercising before work
D. Regular exercise can help promote sleep but should not be performed too close to your bedtime or it can interfere with sleep; try exercising before work
There is a growing recognition that adverse life experiences due to a variety of reasons underlie a wide range of psychiatric disorders and medical problems. According to a seminal research study on adverse childhood experiences (ACE), a positive relationship exists between ACE and which of the following disorders?
A. Alcoholism, anxiety, depression, diabetes, and heart disease
B. Alcoholism, anxiety, heart disease, sleep disorders, and schizophrenia
C. Alcoholism, anorexia, depression, diabetes, and schizophrenia
D. Alcoholism, anxiety, depression, diabetes, and schizophrenia
A. Alcoholism, anxiety, depression, diabetes, and heart disease
In a psychiatric emergency, the psychiatric mental health nurse practitioner (PMHNP) is aware that the most important goal of the interview is self-protection. What can the PMHNP do to keep himself or herself safe?
A. Know as much about the person as possible prior to starting the interview
B. Inform the patient that violence is not acceptable
C. Enter the room alone, in order to build a therapeutic alliance
D. Make sure the patient is restrained before beginning the evaluation
A. Know as much about the person as possible prior to starting the interview
The American College of Obstetricians and Gynecologists (ACOG) recommends screening for postpartum depression with a validated screening tool. Which of the following is a validated screening tool which has been recommended by ACOG?
A. Edinburgh Postnatal Depression Scale (EPDS)
B. Major Depression Inventory (MDI)
C. Montgomery-Asberg Depression Rating Scale (MADRS)
D. Hamilton Rating Scale for
...
A 36 y/o woman was fired from her job as a paralegal at a law firm. She had worked for the same attorney for 10 years. As soon as she came in the door from work, her husband noticed she appeared upset and asked her is she was alright. She immediately started yelling at her husband because he had not given their 5 y/o daughter a bath and had not cleaned the house. Which of the following defense mechanisms is being demonstrated by this woman?
A. Conversion
B. Dissociation
C. Displacement
D. Rationalization
C. Displacement
When questioning a patient regarding alcohol use during an intake, the patient tells you he only drinks socially. Which initial response is most appropriate?
A. I am glad you are responsible drinker
B. Do other people in your household drink alcohol?
C. What amount and what kind of alcohol do you drink in a week?
D. Many people with alcohol issues say they are social drinkers.
C. What amount and what kind of alcohol do you drink in a week?
A 44 y/o man presents to the psychiatric mental health nurse practitioner at his wife's insistence. The patient was hospitalized for a mild hear injury after a motor vehicle accident four weeks ago. He reports a 3 year history of drinking alcohol. The patient states he was at the store a week ago when he realized the store clerk was an imposter replacing his wife. The patient's wife insists that her husband is delusional and she intends to file for divorce if he does not get help. Which of the following types of delusions is the patient expressing?
A. Clerambault syndrome
B. Delusion of doubles
C. Capgras syndrome
D. Fregoli phenomenon
C. Capgras syndrome
Violence directed toward women by an intimate partner is a serious health problem worldwide. Which of the following women has the greatest risk factors for being the victim of violence?
A. 42 y/o, divorced, Caucasian woman dating a recently divorced man in Denver, Colorado
B. 35 y/o, pregnant, African-American woman living with her husband in suburb of Dallas, Texas
C. 17 y/o, single, Native Alaskan woman living with employed boyfriend in Gelena, Alaska
D. 26 y/o, recently separated, Asian American woman living in Boston, Massachusetts
C. 17 y/o, single, Native Alaskan woman living with employed boyfriend in Gelena, Alaska
In assessing possible sexual abuse of a 4 y/o child, which of the following would not be indicated?
A. Has anyone else asked you to take off your clothes?
B. Has anyone done something you didn't like to your body?
C. Has anyone ever taken your picture without your clothes on?
D. Has anyone invited you to a birthday pool party?
D. Has anyone invited you to a birthday pool party?
In advising parents how to reduce the risk for teen substance abuse when there is positive family history of alcohol dependence, a psychiatric-mental health nurse practitioner encourages all of the following recommendations except:
A. Acknowledgement of family risk factor and open discussion with teen
B. Parental presence and involvement in child's school and sports activities
C. Random urine testing using home drug testing kits
D. Parental networking and supervision of any teen parties
C. Random urine testing using home drug testing kits
When assessing a client, what is the most important predictor of potential for violence?
A. History of seizures
B. History of head injury
C. History of aggressive rage
D. History of substance abuse
C. History of aggressive rage
A patient was started on an antipsychotic medication two weeks ago and is now experiencing the following symptoms: inability to sit still, pacing, and feelings of inner restlessness. He does not complain of any anxiety or being worried about anything in particular. Which of the following rating scales would be the most appropriate to assess these symptoms?
A. Barnes Akathisia Rating Scale (BARS)
B. Abnormal Involuntary Movement Scale (AIMS)
C. Simpson Angus EPS Scale
D. Dyskinesia Identification System Condensed User Scale (DISCUS)
A. Barnes Akathisia Rating Scale (BARS)
Which of the following statements would be most likely to be effective in changing sexual behavior when counseling a sexually active 15 y/o adolescent girl?
A. Always use condoms when having sex
B. Use the sample condom
C. Require your partner to use a condom
D. Always carry condoms in your purse
B. Use the sample condom
As the psychiatric mental health nurse practitioner (PMHNP) working with a young female recently diagnosed with bipolar disorder, and using a recovery model, what will be the focus of your interactions with this patient?
A. Assisting in gainful employment
B. Psychoeducation about her disease process
C. Focus on her feelings experience, and what she wants to achieve
D. Focus on the side effects of her medications
C. Focus on her feelings experience, and what she wants to achieve
When child, adult partner, or elder abuse is suspected, the Psychiatric-Mental Health Nurse Practitioner needs to conduct an abuse assessment screen in privacy, away from the partner, the child's parents or guardians, or the elder person's relative or companion. Simple, direct questions in a nonjudgmental interview are indicated. Which of the following would be an appropriate abuse screening question?
A. Within the past year, has anyone ever forced you to do something by threatening you with a gun?
B. Within the past year, has anyone ever threatened to kill you?
C. Within the past year, have you been hit, slapped, kicked or otherwise physically hurt by someone?
D. Within the past year, have you ever threatened or tried to commit suicide to escape the abuse?
C. Within the past year, have you been hit, slapped, kicked or otherwise physically hurt by someone?
A 14 y/o girl admitted to a psychiatric unit following an overdose on alcohol and benzodiazepines after the breakup of a relationship has made seductive comments to her roommate, the Psychiatric-Mental Health Nurse Practitioner needs to include the topic of sexual orientation. What is the best introductory approach to this topic?
A. Are you attracted to girls rather than boys?
B. Did you overdose after breaking up with a girlfriend or boyfriend?
C. What is your experience in sexual relationships?
D. Are you sexually active?
C. What is your experience in sexual relationships? [Show Less]